World Cancer Day: #CloseTheCareGap

ZIMBABWE yesterday joined the world in commemorating World Cancer Day under the international theme: “Close the care gap”.

It is imperative to share information about the current cancer situation in Zimbabwe so that we all work together in reducing the burden by closing existing cancer care gaps in Zimbabwe.

A lot can be done in areas of cancer prevention, early detection, treatment and care.

Cancer is now acknowledged as a major cause of morbidity and mortality in Zimbabwe, with over 7 500 new cancer cases and over 2 500 deaths being recorded per year.

Cancer continues to be on the increase in Zimbabwe, according to the Zimbabwe National Cancer Registry 2018 Annual Report.

The most frequently occurring cancers among Zimbabweans of all races in 2018 were cervix uteri (21 percent), prostate (11 percent), breast (8 percent), non-Hodgkin lymphoma (NHL) (5 percent), oesophagus (4 percent), Kaposi sarcoma (KS) (4 percent), colo-rectal (4 percent), stomach (3 percent) and liver (3 percent).

The other cancers accounted for 37 percent of the registered malignancies.

A total of 293 paediatric cancers (age 0-14) of all races were registered in 2018. In the same year a total of 2 743 cancer deaths were recorded.

These statistics call for coordinated efforts to close the current cancer care gaps in cancer awareness, prevention, diagnosis and treatment of cancer.

Cancer situation in Zimbabwe

Decentralisation of cervical cancer screening services by the Government and its partners is a most welcome move.

The Cancer Association of Zimbabwe is supportive of this initiative and therefore urges more partners to come aboard and help in availing this important service to rural communities.

Cancer is becoming a generalised disease unlike before. Increase in cancer cases among the general population of Zimbabwe is putting pressure on the available cancer service centres and public health institutions.

HIV related cancers are on the increase. In fact, almost 60 percent of all new cancer cases are HIV and AIDS related.

Most of the reported cancer cases are diagnosed late. At least 80 percent of the cases are reported very late at the health institutions, resulting in less chances of treatment success and high cost of treatment.

Early detection and appropriate treatment not only improve prognosis, but also reduces the cost of treatment.

There a lot of myths and misconceptions on cancer among the general population of Zimbabwe.

These myths and misconceptions act as barriers to cancer prevention, early diagnosis and treatment.

The most common myth is that cancer cannot be treated using the conventional treatment modalities and this is resulting in late presentation of cancers.

Though not ascertained as of now, it cannot be doubted that some of the cancer patients are falling prey to some individuals who claim to cure cancer using treatment modalities which are not yet approved.

We, therefore, urge cancer patients to get the right treatment advice from the accredited medical practitioners.

There is late commencement of treatment even when diagnosed of cancer due to both myths and misconceptions on cancer treatment and unaffordability of the cost of treatment.

Cancer education, screening, diagnosis and treatment services remain highly centralised to major towns.

Despite cancer diagnosis and treatment cost being high, there are other “hidden costs” to cancer that some vulnerable patients may endure.

These hidden costs include:

◆ The cost of travelling long distances to access cancer screening and treatment services.

◆ Accommodation and meals in urban areas during diagnosis and treatment from home.

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Myths and misconceptions Challenges Recommendations for the national cancer intervention

Extensive cancer education programmes

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Sustainable financial resource mobilisation for comprehensive national cancer programmes. This will enable decentralisation of cancer information dissemination, screening, diagnosis and treatment services and a multi-sectoral approach in the management of cancer. Introduction of sin and sugar taxes by Government of is a step in the right direction.

More local research on cancer is required to guide national cancer intervention. Essential cancer medicines (WHO model list) should be availed through the public health pharmaceutical route and to be accessed at pharmacies at public health institutions across the country. Social protection such as Assisted Medical Treatment Orders (AMTOS), medical travel warrants and food vouchers for vulnerable cancer patients such as patients without medical insurance, people living with disabilities, children and the elderly seeking cancer treatment, to be revived and sustained. Cancer knows no boundary; we therefore need to come together as one in order to win our fight against cancer.

Former Secretary-General of the United Nations, Ban Ki-moon, once said: “On World Cancer Day, let us resolve to end the injustice of preventable suffering from this disease as part of our larger push to leave no one behind.”

There are cancer knowledge level gaps in Zimbabwe because of common cancer myths and misconception.

Health education is more pronounced on communicable as compared to non-communicable diseases. Lack of knowledge leads to delayed presentation of cases at health institutions.

Increase in cancer awareness can empower people to recognise early warning signs, make informed choices about their health and counter their own fears and misconceptions about cancer.

“Close the care gap” — in early detection, treatment and palliative care services

Over the years, Zimbabwe has improved accessibility to screening of common cancer particularly cervical cancer.

However, there are still gaps in the provision of screening for other common cancers such as prostate, breast and colon cancers.

High user fees, centralisation of cancer screening and treatment services and breakdown of radiotherapy machines reduces accessibility to these vital life-saving cancer services.

“Close the care gap”: — in the availability, affordability and accessibility of essential cancer medicines

Most cancers in Zimbabwe can be treated, however, the cost of medication is expensive for many patients, resulting in failure to commence or to complete the prescribed treatment regimes.

“Close the care gap”: — in funding and resource mobilisation for cancer:

The nation can increase investment in cancer prevention and control than dealing with the consequences. Failure to invest in cancer prevention means that the nation will not be able to cope with the increase in the cases and this will retard development due to increased health spending.

Cancer burden, if not controlled is likely to retard Zimbabwe’s progress towards achieving the Sustainable Development Goals.

“Close the care gap”: — In the coordination of national cancer programmes Zimbabwe cancer burden is increasing every year and this calls for the need to have a national coordination mechanism that oversees interventions to sustain the progress made so far and harness the current global innovations and opportunities in cancer care.

Now that Zimbabwe has the Health Commission in place, there is need for a rejuvenated, functional cancer coordination mechanism.

◆ to counter the current myths and misconceptions about cancer which are acting at barriers to cancer prevention, screening, diagnosis and treatment. Subsidised cancer screening, diagnosis and treatment services and improving the capacity provincial and district public health institutions in cancer management.

National Cancer Policy Focus areas for closing the cancer care gap in Zimbabwe

Lovemore Makurirofa writes on behalf of the Cancer Association of Zimbabwe.